title: Successful fusion of remote type II odontoid fracture using anterior screw fixation of the odontoid and rhBMP-2: report of two cases.
abstract: Anterior screw fixation of the odontoid is contraindicated in remote type II fractures. The alternative surgical treatment consists of a posterior C1 to C2 or an occiput to C3 fusion, which is met with much resistance by patients as this option limits head motion, especially rotational movement. Furthermore, elderly patients may not be medically fit to undergo surgery of this magnitude. This report presents two remote type II odontoid fractures in elderly patients (67 and 73 years of age) who were successfully treated by means of anterior screw fixation of the odontoid along with an injection of recombinant human bone morphogenic protein (rhBMP-2) (Medtronic Inc.) into the fracture line with infiltration of the fibrous union tissue and adjacent anterior longitudinal ligament. To our knowledge, this is the first documented report of solid fusion of remote type II odontoid fracture treated with rhBMP-2 and anterior screw fixation. The authors believe that this technique may be a viable alternative for the treatment of failed odontoid fractures older than six months.
authors.affiliation: Sanford Research, Sioux Falls, USA.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Morgan
authors.forename: Wilson T
authors.initials: WT
authors.lastname: Asfora
mesh_terms: D000368:Aged; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome